New NY Crossroads

First Name

Last Name

YES, it is OK to use my real name on your web site
NO, please do not use my real name on your web site

Email

Country of Birth

Birthdate: mm/dd/yyyy

Male
Female

Country Where You Live Now

Please share a personal story about your life as an
immigrant in the United States or any other country.
Please feel free to write as much as you want.

Please share any other comments about your life as an immigrant. Feel free to write as much as you want.

Consent Agreement.
1. Grant of Consent. By submitting this form ("Your Story") you, your family, your relations and your heirs (hereafter: "You" and "Your") agree and consent New NY Crossroads, it's owners, employees and trustees (hereafter: "New NY Crossroads" and "Our") reserves the right to use your story and photos on the New NY Crossroads website as well as on any public and private publications and print or electronic media. 2. Reservation of Rights. Submission of this form does not guarantee your story will be used by New NY Crossroads. New NY Crossroads reserves the right to maintain your story on file indefinitely for any future related projects. 3. Permitted Use. You agree that New NY Crossroads reserves the right to use and edit your story as deemed fit for appropriateness, style and grammatical considerations as determined in the best interests of the website and any print material. 4. Limited Liability. You agree to hold New NY Crossroads free from liability due to any unintentional misrepresentations and any personal or familial dissatisfaction of your story due to editing. 5. Restricted Rights. You agree to no right or claim to acknowledgement or compensation whether financial, verbal, written or contractual. 6. Cancellation of Consent. If you are in any way dissatisfied or unhappy with your story as it appears on the website, you can request a complete removal of your story and all of its parts and quotes by sending an electronic mail request. You must also include your full name, Story ID number and phone number in order for your request to be fulfilled. 7. Miscellaneous. If you feel your story was submitted in error or if you suspect your story was fraudulently submitted, you may request removal of your story as described in section 6. 8. By you submitting this form, you indicate you fully understand and fully agree to all terms and conditions of the Consent Agreement stated herein.

You must accept the Consent Agreement to post your story.
Please check this box if you agree to the Consent Agreement.